Purpose: The Cooperative Extension System (Extension) has implemented concerted efforts toward health promotion in communities across the nation by acting as an intermediary between communities and universities. Little is known about how these intermediaries communicate and learn about existing evidence-based programming. This study serves to explore this gap by learning about information sources and channels used within Extension. Design: Sequential explanatory mixed methods approach. Setting: National Cooperative Extension System. Participants: Extension community-based health educators. Methods: A nationally distributed survey with follow-up semistructured interviews. Survey results were analyzed using a Kruskal-Wallis 1-way analysis of variance test paired with Bonferroni post hoc. Transcripts were analyzed by conventional content analysis. Results: One hundred twenty-one Extension educators from 33 states responded to the survey, and 18 of 20 invited participants completed the interviews. Educators’ information seeking existed in 2 forms: (1) information sources for learning about programming and (2) channels by which this information is communicated. Extension educators reported contacting health specialists and other educators. Extension educators also reported using technological means of communication such as e-mail and Internet to reach information sources such as peers, specialists, academic journals, and so on. Conclusion: Extension state specialists were preferred as primary sources for intervention information, and technology was acknowledged as an easy contact channel. This study identifies county-based health educators’ information structures and justifies the need for future research on the role of specialists in communication efforts for educators.
Introduction: A number of effective physical activity programs for older adults exist, but are not widely delivered within community settings, such as the Cooperative Extension System. The purpose of this paper was to determine if an evidence-based intervention (EBI) developed in one state Extension system could be scaled-out to a new state system.Methods and results: The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide an iterative evaluation of three translational stages. Stage 1: Before program adoption, Extension health educators were surveyed and interviewed to assess physical activity programming perceptions and factors that may influence their decision to attend training or deliver the program in practice. Results indicated that a virtual, scalable training protocol would be necessary and that training needed to include hands-on instruction and be catered to those who were less confident in physical activity program delivery. Stage 2: Training attendees were surveyed pre- and post-training on factors related to the adoption-decision making process and contacted post-training to assess program delivery status. Training did not influence perceptions of the program, intent to deliver, or confidence in delivering the program. Stage 3: During program implementation, the program was evaluated through the RE-AIM framework by surveying across three key stakeholder groups: (1) program participants, (2) potential delivery personnel, and (3) Extension administrators. Findings indicate that the program has the potential to reach a large and representative proportion of the target audience, especially in rural areas. However, adoption and implementation rates among Extension health educators and community partners were low and data collection for effectiveness, implementation, and maintenance was a challenge.Conclusion: Overall, the results indicate initial struggles to translating and evaluating the program in a large, rural state. Implications for practice include making system-level changes to increase physical activity program adoption rates among Extension health educators and improve data collection and program evaluation through this community-based organization. More work is needed to identify infrastructure support and capacity to scale-out EBIs.
BackgroundGhana is experiencing an epidemiological shift in public health issues toward non-communicable diseases that are underpinned by modifiable health behaviors. Physical activity rates have decreased, especially among older adults, coinciding with urbanization and an increase in sedentary work. Community-based physical activity programs are a recommended method of increasing physical activity levels; however, none currently exist in Ghana. The aim of this exploratory study was to determine older Ghanaian adults’ perceptions of physical activity and asses fit and feasibility of adapting and delivering a physical activity program for this population.MethodsThrough a concurrent exploratory mixed-methods design, data were gathered from Ghanaian older adults (N = 123) during focus groups (N = 10) conducted at one diabetes clinic and nine churches across three urban areas. Qualitative data were collected using a semi-structured script that prompted for responses related to physical activity perceptions and the fit and feasibility of physical activity program characteristics. Quantitative data were collected through a questionnaire assessing participant demographics, physical activity levels, and health rating as well as physical activity knowledge and self-efficacy.ResultsFindings indicate that older adults in Ghana have a need for and an interest in physical activity promotion. Participants had positive perceptions of being physically active, but were unaware of physical activity guidelines and how to meet them. Peer influence and health care providers’ recommendations were motivating factors for physical activity participation. As for desired physical activity program characteristics, participants expressed interest in group-based activities and becoming peer leaders and preference for a church-based program.ConclusionsThe results suggest that a group-based physical activity program encouraged by health care providers and delivered at churches through a train-the-trainer model would be well received by aging adults from three urban areas of Ghana. In addition, education on physical activity types is needed, along with better dissemination and education on Ministry of Health physical activity guidelines. This exploratory work highlights preliminary support for a group- and community-based physical activity program for the aging population in Ghana. Beginning with the end in mind, these program characteristics should be considered when adopting, adapting, and implementing an intervention with this population.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1095-1) contains supplementary material, which is available to authorized users.
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